Pesonen Eero, Keski-Nisula Juho, Passov Arie, Vähätalo Raisa, Puntila Juha, Andersson Sture, Suominen Pertti K
Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Anaesthesia and Intensive Care, Children's Hospital, University of Helsinki and Helsinki University Hospital; Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Cardiothorac Vasc Anesth. 2017 Dec;31(6):1952-1956. doi: 10.1053/j.jvca.2017.05.013. Epub 2017 May 4.
Corticosteroids possess cardioprotection in experimental cardiac ischemia/reperfusion. The authors hypothesized that if cardioprotection of corticosteroids occured during pediatric cardiac surgery, then methylprednisolone used in cardiopulmonary bypass prime would reduce postoperative concentrations of heart-type fatty-acid-binding protein, a cardiac biomarker.
A double-blind, placebo-controlled, randomized clinical trial.
Operating room and pediatric intensive care unit of a university hospital.
Forty-five infants and young children undergoing ventricular or atrioventricular septal defect correction.
The patients received one of the following: 30 mg/kg of methylprednisolone intravenously after anesthesia induction (n = 15), 30 mg/kg of methylprednisolone in cardiopulmonary bypass prime solution (n = 15), or placebo (n = 15).
Plasma heart-type fatty-acid-binding protein (hFABP) was measured. Preoperatively, hFABP did not differ among the study groups. Methylprednisolone administered preoperatively and in the cardiopulmonary bypass prime solution reduced hFABP by 44% (p = 0.010) and 38% (p = 0.033) 6 hours postoperatively. hFABP significantly correlated with concomitant troponin T after protamine administration (R = 0.811, p < 0.001) and 6 hours postoperatively (R = 0.806, p < 0.001).
Methylprednisolone in cardiopulmonary bypass prime solution administered only a few minutes before cardiac ischemia confered cardioprotection of the same magnitude as preoperative methylprednisolone as indicated by hFABP concentrations. Rapid cardioprotective actions of corticosteroids in pediatric heart surgery observed previously experimentally may have occurred.
在实验性心脏缺血/再灌注中，皮质类固醇具有心脏保护作用。作者推测，如果皮质类固醇在小儿心脏手术期间发挥心脏保护作用，那么用于体外循环预充液中的甲泼尼龙将降低术后心脏生物标志物——心型脂肪酸结合蛋白的浓度。
一项双盲、安慰剂对照、随机临床试验。
一所大学医院的手术室和儿科重症监护病房。
45例接受心室或房室间隔缺损矫正术的婴幼儿。
患者接受以下其中一种处理：麻醉诱导后静脉注射30mg/kg甲泼尼龙（n = 15）、体外循环预充液中加入30mg/kg甲泼尼龙（n = 15）或安慰剂（n = 15）。
检测血浆心型脂肪酸结合蛋白（hFABP）。术前各研究组的hFABP无差异。术前及体外循环预充液中给予甲泼尼龙可使术后6小时hFABP分别降低44%（p = 0.010）和38%（p = 0.033）。给予鱼精蛋白后及术后6小时，hFABP与肌钙蛋白T显著相关（R = 0.811，p < 0.001）（R = 0.806, p <0.001）。
在心脏缺血前几分钟给予体外循环预充液中的甲泼尼龙，其心脏保护作用与术前甲泼尼龙相当，hFABP浓度可作为指标。先前在实验中观察到的皮质类固醇在小儿心脏手术中的快速心脏保护作用可能已经发生。
